I regularly exchange my white coat for a jacket and tie as I take off my clinical hat and put on my administrative hat. When doing this, my perspective changes slightly─to how I can best serve my patients while at the same time keeping a sustainable business.
Upon learning of the “triage out” concept, my initial visceral reaction was strong opposition. This practice, which sends low acuity ED patients to primary care venues, seemed to conflict with my commitment to patient care. But as the landscape changes and there is an overwhelming increase in primary care patients presenting to the ED, I now see the triage out option as a viable way to not only serve the needs of the ED, but also to steer patients towards the primary care they need.
Recently, there have been two studies that indicate benefits for patients who are triaged out. The results of a one year trial published on February 15, 2013, were that for every 11 patients escorted from the ED to a primary care clinic, one additional primary care follow-up visit would occur within a year. If one out of every 11 patients were to start using a primary care clinic instead of the ED for their primary care, this would help reduce ED crowding and also allow the patients to obtain the preventative care they need.
In addition, another study on the ambulance transport of inebriated patients directly to detox from the field showed promising results. Of the 111 people who were diverted to detox and admitted there, only 4% were returned to the ED, and only one of these was admitted to the hospital. Again, in addition to reducing congestion in the ED, this program benefitted the patients by sending them to a facility better equipped to provide the help and support needed to treat addiction.
The economic benefits to both the patient and the hospital from a triage out system are obvious. The patient avoids costly medical bills by being treated at a lower cost facility, or at a low-fee or no-fee outpatient clinic where necessary. The hospital avoids having to provide treatment that is not eligible for any county funding to offset our costs if patients cannot pay.
I trained in Emergency Medicine, and I would prefer to provide treatment for emergencies rather than primary care in the ED. But most of all I want to help people be healthy. It appears that the triage away system may be more than just a way to reduce crowding in the ED. It may also be a way to substantially help people maximize their long term health.